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The Trump administration...finalized a rule meant to make it easier for state Medicaid programs, commercial insurers and drugmakers to enter into "value-based" arrangements tying prescription drug payments to clinical outcomes... The rule overhauls existing regulations...Under these types of deals, payers negotiate prices with drugmakers based on outcomes and evidence-based measures like reduced hospitalizations or lab visits, and aren't accountable for the full price if those measures aren't met...CMS estimates that value-based drug deals emerging in the wake of the final rule could save federal and state governments up to $228 million through 2025...READ MORE

The U.S. Centers for Medicare and Medicaid Services issued a proposed rule Thursday aimed at improving the electronic exchange of healthcare data among payers, providers and patients...The rule would require Medicaid, CHIP and QHP programs to build HL7 FHIR-based APIs to support data exchange and prior authorization. It also includes a proposed API standard for healthcare operations nationwide...The proposed rule seeks to enhance the patient access API by requiring the use of specific HL7 implementation guides by impacted payers...READ MORE

President Donald Trump said that Americans in the Medicare program for the elderly and disabled will be sent $200 discount cards for prescription drugs within weeks, potentially putting cash in their pockets ahead of his November re-election...Assuming they are sent to 33 million Medicare beneficiaries, the figure Trump used, the cards would cost about $6.6 billion...Money for the cards will be drawn from a demonstration program Medicare uses to test new payment systems and other projects, and the cost will be offset by future savings generated from new price cuts Trump has ordered for drugs bought by Medicare, according to a White House official. The cards can be used for prescription drugs co-pays, the official said, but didn’t elaborate...READ MORE

After touting a series of executive orders on drug pricing in late July, President Donald Trump has now unveiled the most significant among them—an order tying Medicare's drug prices to much lower costs in other developed countries. The biopharma industry pushed back hard, and it’s unclear exactly when or how the changes would be implemented...The executive order...says Medicare should not buy certain Part B or Part D drugs unless at prices paid by “at a minimum, the lowest price at which the manufacturer sells that drug to any other developed nation.” In Part D, the plan would apply “where insufficient competition exists” and where “seniors are faced with prices" higher than those in other developed nations...READ MORE

The American Hospital Association is seeking an emergency stay to delay enforcement of the Trump administration's price transparency when it goes into effect Jan. 1...The AHA and other appellants argue in the filing that the rule should be put on hold until their legal challenge plays out. Hospitals are awaiting a decision from a federal appeals court on the regulation following oral arguments in October...The rule would require hospitals to post payer-negotiated payment rates for 300 shoppable services online beginning Jan. 1. The goal is to encourage patients to shop around for care...READ MORE

The Trump administration announced it will cover a vaccine for COVID-19 at no cost to Medicare beneficiaries...The Centers for Medicare & Medicaid Services released an interim rule on Wednesday that aims to remove regulatory barriers for seniors to get the vaccine, which is expected to be approved by early next year...READ MORE

Hospital groups praised the Trump administration's decision Monday to pull a Medicaid rule aimed at fiscal accountability, which providers warned could lead to massive cuts in reimbursement..."up to $50 billion in annual funding for the Medicaid program was on the line" if the rule had been finalized..."We appreciate CMS for acknowledging the harmful consequences this rule would have for patients,"..."Hospitals and health systems will be greatly relieved when the proposed rule is formally withdrawn."...The Centers for Medicare & Medicaid Services first unveiled the Medicaid Fiscal Accountability Rule in November, with the goal of tamping down on schemes used by states to boost federal matching funds in the program...READ MORE

Drug manufacturers have had little choice but to act on their own to identify and mitigate the impact of duplicate 340B discounts...Marcy Imada...director at Deloitte & Touche LLP... said preventing duplicate 340B discounts “has proven to be a challenging and long-standing problem for the industry, and in particular for manufacturers. There have been numerous government studies and recommendations provided over the years to try to address this duplicate discounts challenge.”...manufacturers have been left with little choice but to take “more proactive steps” and implement “new strategic initiatives,”... “At least a couple of manufacturers have communicated plans to limit sales at 340B discounted prices billed to a covered entity and shipped to 340B contract pharmacies,” she said...READ MORE

The head of Centers for Medicare & Medicaid Services reiterated support for Medicaid work requirements as enrollment in the program swells this year...CMS Administrator Seema Verma spoke about work requirements...Her remarks come less than a month after a study in Health Affairs found that work requirements in Arkansas did not lead to more employment...“I am supportive of states making decisions about their programs and deciding what has worked best,” Verma said...She added that 20 states have been interested in the work requirements program...CMS has approved waivers for 10 states but currently no states are running a work requirement program. Arkansas, Indiana, Michigan and New Hampshire all started work requirement programs, but court rulings struck them down. Utah implemented its work requirement program in January, but it was suspended in April due to COVID-19...Verma said that the goal of the programs were to help improve the health of able-bodied Medicaid beneficiaries...READ MORE

A federal program aimed at lowering Medicare costs by incentivizing providers to move from fee-for-service to value-based care models generated $1.2 billion in net savings to Medicare last year, the Centers for Medicare & Medicaid Services announced...CMS Administrator Seema Verma credited savings seen under the Medicare Shared Savings Program to recent rules that shortened the pathway for financial risk...These results are additional evidence that physician-led practices can be successful in generating savings through value-based care..."Once again, physician-led ACOs out-performed hospital ACOs,"..."What we need now is to help more practices participate in these models of care."...READ MORE